echemi logo
Product
  • Product
  • Supplier
  • Inquiry
    Home > Active Ingredient News > Immunology News > Winners win the world, and drugs with high retention rates are the key to long-term treatment of RA

    Winners win the world, and drugs with high retention rates are the key to long-term treatment of RA

    • Last Update: 2021-03-22
    • Source: Internet
    • Author: User
    Search more information of high quality chemicals, good prices and reliable suppliers, visit www.echemi.com
    *It is only for medical professionals to read.
    Biological agents with high retention rate are the better choice for RA patients in long-term treatment.

    Chronic disease is a type of lifelong disease.
    With the development of the disease, patients often show progressive impairment or disability, which seriously damages their physical and mental health.

    Rheumatoid arthritis (RA) is a chronic progressive disease that cannot be cured.
    It belongs to the category of chronic diseases.
    Patients need long-term follow-up, treatment, and medication to control and improve their condition.

    Therefore, in the process of chronic disease management of RA, the retention rate of drugs is particularly important, and it is the key to ensuring long-term stable treatment of patients.

    Among RA treatment drugs, biological agents are a new type of drugs with clear targets.

    With the rapid development of biomedicine, more and more RA patients choose biologics for treatment.

    However, the survival rate of different biological agents in the treatment process is quite different.

    Today, we will discuss the retention rate of various biological agents in the treatment of RA.

    1Why do we care about drug retention rate? The drug retention rate refers to the proportion of patients who keep using the same drug for a certain period of time.
    It is considered to be a comprehensive indicator reflecting the overall efficacy, safety and tolerability of the drug [1-2].

    In addition to efficacy and safety, the availability of drugs, the ease of treatment management, and doctor-patient preferences are all factors that influence the retention rate [3].

    In the long-term treatment of RA, choosing a drug with a higher retention rate means that a more stable treatment management strategy can be maintained.
    This not only improves the efficiency of clinical management, but also reduces the medical cost of patients with repeated visits and retests, which helps To achieve long-term remission and improvement of the disease [2,4-5].

    Studying drug retention rate will facilitate the formulation of effective clinical treatment intervention strategies and is the key to the management of chronic disease in RA.

    2What is the difference in the retention rate of each biological agent in different populations? At present, biological agents suitable for the treatment of RA are mainly divided into two categories.
    One is tumor necrosis factor (TNF-α) inhibitors, which exert its effect by blocking the inflammatory factor TNF-α that has a pathogenic effect with high selectivity.
    Efficacy; the other category is non-TNF-α-targeted biological agents, including interleukin antagonists such as tocilizumab, abatacept that targets T cells, and rituximab that targets B cells Monoclonal antibodies and so on.

    Research teams in many countries have explored the use of biological agents in RA patients in their countries, and compared the retention rates of different types of biological agents.

    A large number of real-world studies have reported that among various biological agents, the T cell costimulatory factor modulator Abatacept has a high retention rate, which may help the long-term chronic disease management of RA patients.

    Korean retrospective cohort study [6] This study used medical information from the Korean National Health Insurance Claims Database and included a total of 2684 RA patients and followed up for 12 months.

    During the period, the biological agents used by the patients included adalimumab, etanercept, golimumab, infliximab (the above are all TNF-α inhibitors), as well as tocilizumab and abatacept.

    The results showed that compared with TNF-α inhibitors, non-TNF-α-targeted biologics showed a higher survival rate, especially in patients who initially used abatacept, with a survival rate of up to 69.
    3% (Figure 1).
    It shows that it has the potential to be used as a first-line biological agent for long-term treatment.

    Figure 1: In the Korean retrospective cohort study, the retention rate of the therapeutic drugs in RA patients who initially used different biological agents was a multi-center, retrospective, and observational study in the United Kingdom [7] The subjects were from January 1, 2013 to 2017 On December 31, there were 213 cases of RA patients who received abatacept treatment (no matter which line of treatment) in 4 centers in the UK.

    Compared with patients receiving other biological agents, the average treatment duration of RA patients who used abatacept in the first-line biological therapy was longer (53.
    4 months vs 17.
    4 months, P<0.
    01).
    After receiving abatacept for December and 24 Months and 36 months later, the retention rates were 85.
    6%, 70.
    9%, and 70.
    9% (Table 1). Table 1: The duration of initial treatment with different biological agents and the treatment retention rate in different time periods.
    French multi-center, observational study [8] The study collected medical treatment from January 2008 to July 2016 in the RIC-France database According to the data, a total of 517 RA patients who started biotherapy with abatacept were included.

    The results showed that the survival rate of abatacept after 12 months of treatment was 68%, and the survival rate after 24 months was 52% (Figure 2).

     Figure 2: In the French observational study, the retention rate of abatacept after 12 and 24 months of treatment in Belgium.
    A 5-year observational study in Belgium.
    [9] This study is part of the international research ACTION study, and 16 different studies in Belgium Centrally conducted, a total of 141 patients with moderate to severe RA were enrolled, of which 135 cases were valid.

    The results of the study showed that the survival rate of abatacept was 80% (95% CI 72%-86%) and 73% (95% CI 64%-80%) at 12 months, 24 months, and 60 months of treatment.
    ) And 51% (95% CI 40%-61%), its use has a high retention rate, good clinical efficacy and safety.

     Figure 3: The retention rate of abatacept in the overall population, those who have never used biological agents and those who have used TNF inhibitors.
    In summary, the research data of RA patient populations in many countries all show that abatacept has been shown in long-term treatment.
    Higher drug retention rate is better than other biological agents.

    3 Choose the right time for medication and advantage population, effectively improve drug retention rate High drug retention rate is the goal pursued in the long-term treatment of RA, and it is also the key factor to achieve the treatment of RA.

    How to increase the retention rate of Abatacept to maximize the benefits? Researchers conducted a more in-depth analysis of this.

    Timing of treatment: early use can help improve drug efficacy and retention.
    ACTION is an international observational study [10], including 2350 patients with moderate to severe RA.
    The purpose of the study is to explore the use of abatacept for 2 years in patients.
    After the retention rate. Among them, 673 patients (28.
    6%) had not used other biological agents before, that is, abatacept was initially used; 1677 patients (71.
    4%) had previously used other biological agents and then switched to abatacept.

    After 2 years of treatment, the survival rate of abatacept in the overall patient population was 47.
    9%.

    In the subgroup analysis, the survival rate of abatacept in patients who had not previously used biological agents was significantly higher than that of patients who had failed to use other biological agents in the past (54.
    5% vs 45.
    2%, P<0.
    001).

    Moreover, its retention rate decreased with the increase in the number of biologics used in the past (Figure 4).

    From the perspective of efficacy, the earlier abatacept is used, the higher the proportion of patients with moderate or good EULAR response, indicating that the treatment response is better (Figure 5).

     Figure 4: The retention rate of abatacept under different treatment timings Figure 5: The treatment response of abatacept under different treatment timings is clear to the dominant population, helping individualized and precise treatment.
    Many research results have shown that anti-citrulline protein Antibody (ACPA)-positive patients are the dominant groups who benefit from treatment with Abatacept.

    For example, Gottenberg et al.
    reported for the first time that ACPA positive indicates that patients with abatacept may have a better treatment response and a higher survival rate [11]; Nusslein et al.
    reported that ACPA-positive RA patients have a higher survival rate for abatacept.
    Gao [12]; Sokolove et al.
    proved that ACPA positivity is associated with a better response to Abatacept through subgroup analysis in the AMPLE study [13,14].
    .
    .
    .
    .
    .
    In 2020, the new research evidence published by Japanese scholars is based on previous data The above further confirmed the relationship between ACPA positive and the retention rate of Abatacept [15].

    This retrospective cohort study used multi-center registration data and included a total of 553 RA patients treated with abatacept.

    The results showed that after 52 weeks of treatment, there was a significant difference in the survival rate of abatacept between the ACPA(-) and ACPA(+) groups (73.
    8% vs 89.
    0%, P=0.
    0002, Figure 6A). Analyzing the reasons for patient withdrawal, the researchers found that the incidence of drug withdrawal due to insufficient response in the ACPA(+) group was significantly lower than that in the ACPA(-) group (3.
    5% vs 14.
    4%, P<0.
    0001, Figure 6B) , And no significant difference was observed in the incidence of discontinuation due to adverse events (6.
    3% vs 6.
    5%, P=0.
    9582, Figure 6C).

    Figure 6: Comparison of the retention rate of abatacept between the ACPA(−) group and the ACPA(+) group.

    (A) Overall drug retention rate; (B) Drug retention rate for discontinuation of treatment due to insufficient response; (C) Drug retention rate for discontinuation of drug due to adverse events.
    Therefore, choose the appropriate treatment time and suitable population/dominant population for individual Chemical precision treatment is very important to improve drug retention rate.

    4 Summary Choosing drugs with high retention rates is the key to long-term treatment and management of chronic diseases.

    Multi-country research data shows that compared with other biological agents, abatacept has a higher retention rate and can play a good efficacy and safety in the long-term treatment of RA.

    In the process of medication, attention should be paid to the timing of medication and the appropriate population.
    The early use of abatacept therapy and individualized medication for its dominant populations will benefit patients more. References: [1] Ebina K, Hashimoto M, Yamamoto W, et al.
    Drug tolerability and reasons for discontinuation of seven biologics in elderly patients with rheumatoid arthritis-The ANSWER cohort study[J].
    PLoS One, 2019, 14(5 ): e0216624.
    [2] Carretero G, Puig L, Carrascosa JM, et al.
    Redefining the therapeutic objective in psoriatic patients candidates for biological therapy[J].
    J Dermatolog Treat, 2018, 29(4):334-346.
    [ 3] No DJ, Inkeles MS, Amin M, et al.
    Drug survival of biologic treatments in psoriasis: a systematic review[J].
    J Dermatolog Treat,2018, 29(5):460-466.
    [4] Hernandez MV, Sanchez-Piedra C, Garcia-Magallon B, et al.
    Factors associated with long-term retention of treatment with golimumab in a real-world setting: an analysis of the Spanish BIOBADASER registry[J].
    Rheumatol Int,2019, 39(3 ):509-515.
    [5] Dalén J, Svedbom A, Black CM, et al.
    Treatment persistence among patients with immune-mediated rheumatic disease newly treated with subcutaneous TNF-alpha inhibitors and costs associated with non-persistence[J].
    Rheumatol Int,2016, 36(7):987-95.
    [6] Park JA, Lee MY, Nam JH, et al.
    Real-world treatment persistence of non-tumor necrosis factor inhibitors versus tumor necrosis factor inhibitors among patients with rheumatoid arthritis in South Korea[J].
    Curr Med Res Opin,2020,36(2):343 -351.
    [7] Choy E, Groves L, Sugrue D, et al.
    Outcomes in rheumatoid arthritis patients treated with abatacept: a UK multi-centre observational study[J].
    BMC Rheumatol, 2021, 5(1):3.
    [8] Salmon JH, Letarouilly JG, Goëb V, et al.
    Actual Persistence of Abatacept in Rheumatoid Arthritis: Results of the French-Ric Network[J].
    J Clin Med,2020, 9(5):1528.
    [9] Westhovens R, Connolly SE, Margaux J, et al.
    Up to 5-year retention of abatacept in Belgian patients with moderate-to-severe rheumatoid arthritis: a sub-analysis of the international, observational ACTION study[J].
    Rheumatol Int,2020, 40(9):1409-1421.
    [ 10] Alten R, Mariette X, Lorenz HM, et al.
    Predictors of abatacept retention over 2 years in patients with rheumatoid arthritis: results from the real-world ACTION study[J].
    Clin Rheumatol,2019,38(5):1413 -1424.
    [11] Gottenberg JE, Ravaud P, Cantagrel A, et al.
    Positivity for anti-cyclic citrullinated peptide is associated with a better response to abatacept: data from the'Orencia and Rheumatoid Arthritis' registry[J].
    Ann Rheum Dis,2012, 71(11):1815-9.
    [12] Nüßlein HG, Alten R, Galeazzi M, et al.
    Real-world effectiveness of abatacept for rheumatoid arthritis treatment in European and Canadian populations:a 6-month interim analysis of the 2-year, observational, prospective ACTION study[J].
    BMC Musculoskelet Disord,2014,15:14.
    [13] Sokolove J, Schiff M, Fleischmann R, et al.
    Impact of baseline anti -cyclic citrullinated peptide-2 antibody concentration on efficacy outcomes following treatment with subcutaneous abatacept or adalimumab: 2-year results from the AMPLE trial[J].
    Ann Rheum Dis,2016, 75(4):709-14.
    [14] Schiff M, Weinblatt ME, Valente R, et al.
    Head-to-head comparison of subcutaneous abatacept versus adalimumab for rheumatoid arthritis: two-year efficacy and safety findings from AMPLE trial[J].
    Ann Rheum Dis,2014,73(1) :86-94.
    [15] Kida D, Takahashi N, Kaneko A, et al.
    A retrospective analysis of the relationship between anti-cyclic citrullinated peptide antibody and the effectiveness of abatacept in rheumatoid arthritis patients[J].
    Sci Rep,2020, 10(1):19717.
     
    This article is an English version of an article which is originally in the Chinese language on echemi.com and is provided for information purposes only. This website makes no representation or warranty of any kind, either expressed or implied, as to the accuracy, completeness ownership or reliability of the article or any translations thereof. If you have any concerns or complaints relating to the article, please send an email, providing a detailed description of the concern or complaint, to service@echemi.com. A staff member will contact you within 5 working days. Once verified, infringing content will be removed immediately.

    Contact Us

    The source of this page with content of products and services is from Internet, which doesn't represent ECHEMI's opinion. If you have any queries, please write to service@echemi.com. It will be replied within 5 days.

    Moreover, if you find any instances of plagiarism from the page, please send email to service@echemi.com with relevant evidence.